title: Fall incidents unraveled: a series of 26 video-based real-life fall events in three frail older persons.
abstract: BACKGROUND
  For prevention and detection of falls, it is essential to unravel the way in which older people fall. This study aims to provide a description of video-based real-life fall events and to examine real-life falls using the classification system by Noury and colleagues, which divides a fall into four phases (the prefall, critical, postfall and recovery phase).
  
  
  METHODS
  Observational study of three older persons at high risk for falls, residing in assisted living or residential care facilities: a camera system was installed in each participant's room covering all areas, using a centralized PC platform in combination with standard Internet Protocol (IP) cameras. After a fall, two independent researchers analyzed recorded images using the camera position with the clearest viewpoint.
  
  
  RESULTS
  A total of 30 falls occurred of which 26 were recorded on camera over 17 months. Most falls happened in the morning or evening (62%), when no other persons were present (88%). Participants mainly fell backward (initial fall direction and landing configuration) on the pelvis or torso and none could get up unaided. In cases where a call alarm was used (54%), an average of 70 seconds (SD=64; range 15-224) was needed to call for help. Staff responded to the call after an average of eight minutes (SD=8.4; range 2-33). Mean time on the ground was 28 minutes (SD=25.4; range 2-59) without using a call alarm compared to 11 minutes (SD=9.2; range 3-38) when using a call alarm (p=0.445).The real life falls were comparable with the prefall and recovery phase of Noury's classification system. The critical phase, however, showed a prolonged duration in all falls. We suggest distinguishing two separate phases: a prolonged loss of balance phase and the actual descending phase after failure to recover balance, resulting in the impact of the body on the ground. In contrast to the theoretical description, the postfall phase was not typically characterized by inactivity; this depended on the individual.
  
  
  CONCLUSIONS
  This study contributes to a better understanding of the fall process in private areas of assisted living and residential care settings in older persons at high risk for falls.
authors.affiliation: Center for Health Services and Nursing Research, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35/4, 3000 Leuven, Belgium. koen.milisen@med.kuleuven.be.
authors.forename: Ellen
authors.initials: E
authors.lastname: Vlaeyen
authors.forename: Mieke
authors.initials: M
authors.lastname: Deschodt
authors.forename: Glen
authors.initials: G
authors.lastname: Debard
authors.forename: Eddy
authors.initials: E
authors.lastname: Dejaeger
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.forename: Toon
authors.initials: T
authors.lastname: Goedemé
authors.forename: Bart
authors.initials: B
authors.lastname: Vanrumste
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000203:Activities of Daily Living / Q000523:psychology*; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006801:Humans; D015994:Incidence; D004856:Postural Balance / Q000502:physiology; D012307:Risk Factors; D014741:Video Recording / Q000379:methods*